Info
🌱 來自: Huppert’s Notes
CNS Infections🚧 施工中
CNS Infections
• Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015;2015(9):CD004405.
- A systematic review of 25 randomized trials that included data from 4121 patients and examined outcomes and adverse effects of corticosteroid use for acute bacterial meningitis. Corticosteroids significantly reduced hearing loss and neurological sequelae but did not reduce overall mortality. This review supports the use of corticosteroids in patients with bacterial meningitis.
• Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001;345(24):1727–1733.
- A prospective cohort study of 301 adults with suspected meningitis. Clinical features associated with an abnormal finding on CT of the head were an age of at least 60 yr, immunocompromise, a history of CNS disease, and a history of seizure within a week of presentation. The following neurologic abnormalities were also associated with abnormal imaging: An abnormal level of consciousness, an inability to answer two consecutive questions correctly or to follow two consecutive commands, gaze palsy, abnormal visual fields, focal deficits, and abnormal language (e.g., aphasia). This study supports the idea that clinical features can be used to identify those who need CT imaging of the head before lumbar puncture.
• How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? JAMA 2006;296(16):2012–2022.
- A systematic review that includes evidence about test accuracy of CSF analysis in adult patients with suspected bacterial meningitis. It demonstrated that a CSF: Blood glucose ratio of 0.4 or less and a CSF WBC count of 500 cells/µL or higher significantly increase the likelihood of bacterial meningitis.